Infectious disease outbreaks rise with opioid epidemic

About Bara Vaida

Bara Vaida (@barav) is AHCJ's core topic leader on infectious diseases. An independent journalist, she has written extensively about health policy and infectious diseases. Her work has appeared in outlets that include the National Journal, Agence France-Presse, Bloomberg News, McClatchy News Service, MSNBC, NPR, Politico and The Washington Post.

Photo: Courtesy of the San Diego Union TribuneTent “cities” have swelled in southern California, creating crowded and unsanitary conditions.

Cases of infectious diseases such as hepatitis A, B and C, sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) have surged as the opioid epidemic has worsened over the past several years, two public health officials said during a Aug. 23 webcast for AHCJ members.

The increasing number of infectious disease cases are likely due to infected needle injections, unprotected sex, homelessness, lack of access to medical care and other socioeconomic challenges associated with people who have physical addictions to drugs and opioids.

Public health officials would like more journalists to be covering these infectious disease outbreaks, because the spread of hepatitis and other infections can affect the broader public.

Hepatitis A “is a health crisis that the CDC [Centers for Disease Control and Prevention] and multiple states are in the midst of addressing,” said Dr. Jonathan Mermin, head of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Hep A outbreaks are continuing to be a major issue for the country.”

Between August 2016 and March 2018, 10 states have reported almost 5,000 cases of Hepatitis A cases, almost double that of the prior two years, according to the CDC. The agency will soon be issuing a Morbidity and Mortality Weekly Report, one of its weekly reports highlighting public health issues, on the outbreak of Hepatitis A and its connection to the opioid epidemic.

“We are hoping this will inspire more attention to the issue,” Mermin said.

Hepatitis is an inflammation of the liver, often caused by one of three different viruses, labeled “A,” “B” and “C” and are spread in different ways. Hepatitis A is usually transmitted through fecal matter. Hepatitis B is spread through bodily fluid like blood or semen and C is spread via blood. There is a vaccine to prevent hepatitis A and B, but not for C. Stories of hepatitis A outbreaks in San Diego, Nashville and Detroit have made headlines over the past year.

The number of hepatitis C cases have also surged. Between 2009 and 2016, the number of people diagnosed annually grew to more than 40,000 from about 10,000, the CDC says. There are drugs to treat hepatitis C, but many people who have become dependent on drugs don’t realize they have the disease and don’t seek help in time. They may then inject a drug and pass the needle on to another person transmitting the infection. About 20,000 people die of Hep C annually, making it one of the biggest infectious disease killers in the U.S.

During the webcast, Mermin also highlighted the rise in pregnant women diagnosed with syphilis, a bacteria that can cause birth defects in the fetus, and is transmitted through sexual activity. There has been a 176 percent increase in congenital syphilis cases since 2012. Further, as the opioid epidemic has grown, progress on preventing the spread of HIV has halted, and in some areas, there have been a rise in reported HIV diagnoses, Mermin said.

The CDC has been challenged in its efforts to curb the outbreaks because “these are hard to reach populations” such as homeless individuals, Mermin said. The agency is working with a cross-section of organizations, from community groups, to hospitals, payors, physicians, public safety officials, and government leaders get hepatitis vaccines to at risk populations and to get medicated treatment assistance to those with physical dependence to drugs.

The CDC has also developed a map of “at risk” communities for infectious disease outbreaks due to the opioid epidemic, which reporters could mine for story ideas, said Mermin.

In Alaska, one of eight states that have declared a public emergency to deal with the opioid epidemic, the state has been offering syringe service programs, so that those with substance dependence can access clean needles, and get access to addiction treatment services, according to Dr. Jay Butler, chief medical officer and director of public health for Alaska’s department of health and social services. He is the past president of the Association of State Health and Territorial Health Officials.

Because people who come to the needle exchange centers then have access to health services, the state has been able to address infectious diseases connected to the opioid epidemic, Butler said.

“There are advantages to being in a libertarian western state,” said Butler, in that there wasn’t regulatory or political resistance to creating a needle exchange program. “The opioid crisis has allowed us to shine a light on… a public health best practice.”